Features of diagnostics of gastroesophageal and duodenogastric reflux in patients with complicated forms of peptic ulcer.

Purpose – to improve the results of surgical treatment of duodenal ulcer due to preoperative diagnosis of concomitant reflux disease and its correction. Before surgery, 46 patients with complicated forms of peptic  ulcer disease underwent pH monitoring and 23 – impedance-pH monitoring. Pathological gastroesophageal reflux was found in 58 cases. Before surgery, esophageal pH monitoring was performed in 46 patients with complicated forms of peptic ulcer disease. Against the background of hyper – and normacidity of the stomach in 39 patients pathological acidic gastroesophageal reflux disease with a significant increase of De Meester index was confirmed. Impedance-pH monitoring was performed before surgery in 23 patients with complicated forms of peptic ulcer and concomitant gastroesophageal reflux. Erosive form of gastroesophageal reflux disease was confirmed endoscopically in all patients with hyperacidity (17) and normal acidity (6) of the stomach. In 19 cases pathological gastroesophageal reflux disease was found. In 13 cases the cause of disorders in anti-reflux barrier was a diaphragmatic hernia of I-II degree. Gastroesophageal reflux disease was caused by increased intragastric pressure due to ulcer stenosis in 6 patients. pH- monitoring in patients with acidic gastroesophageal reflux allows to establish a pathological or physiological reflux. Conducting impedance-pH monitoring allows to determine the number of reflux episodes and their qualitative characteristics (acidic or alkaline; liquid, gas or mixed), as well as to determine the indications for a differentiated approach in the treatment of gastroesophageal reflux

EPIDEMIOLOGICAL FEATURES OF MELANOMA SKIN CANCER AND SURVIVAL OF ONCOLOGY PATIENTS IN KRASNODAR REGION

Aim. To assess the effectiveness of preventive, diagnostic and therapeutic work of the oncological service of Krasnodar Region, analyze the epidemiological features of morbidity, mortality, indicators reflecting the diagnosis (the proportion of early detection, neglect) in patients with melanoma skin cancer for the period 2007–2017, and the survival of cancer patients in Krasnodar Region for the period 2007–2016.Materials and methods. Subjects of the study were patients with newly diagnosed melanoma skin cancer in Krasnodar Region for the period 2007–2017. Using an automated information and analytical system the Population Cancer Registry, survival of 3 961 patients with melanoma skin cancer for the period 2007–2016 was analyzed. Standardized rates of morbidity and mortality were calculated according to the accepted world standard with the same age groupings. Statistical processing of data according to the studied indicators was carried out using statistical software packages Statistica. The reliability of the difference in the relative indicators was determined by the t test of the Student, the significance level was adopted as p <0.05.Results. For the period from 2007 to 2017, there has been a significant trend towards an increase in the incidence of melanoma skin cancer of the population of Krasnodar Region. The incidence of melanoma skin cancer in Krasnodar Region is higher than the average for the Russian Federation, which may be due to the presence of an increased level of insolation. During the analyzed period there has been a decrease in the indicator of neglect. With the increase in the stage of melanoma skin cancer, the survival rates both in general among all the diseased and among patients of working age are decreasing. The highest rates of observed and adjusted survival in patients with melanoma skin cancer reduce in the first three years from the date of diagnosis. The indicators of the observed and corrected survival of men of working age with melanoma skin cancer are lower than in women of working age. The indicators of the observed and corrected survival of women of working age with melanoma skin cancer are higher than among the population of all age groups.Сonclusion. The study showed a high level of early diagnosis and quality of treatment for patients with melanoma skin cancer in the Krasnodar Region, as positive trends in the rates of observed and adjusted survival of patients were noted

Endoscopic endonasal approaches to the skull base tumors: minimally-invasive approach with achievement of radicality. Our experience

Objective: to optimize surgical tactic of endoscopic endonasal transsphenoidal (EET) approaches in cases of tumors with intra- and extracranial extension.Material and methods. For the period of 2013–2019, we retrospectively reviewed 39 patients with tumors of intra-extra skull base location or just extracranial extension. Tumor location and pathology: tumors in pterygopalatine fossa (paraganglioma, carcinoma, neurilemmoma, neurofibroma, chondrosarcoma) — 10 (25.6 %), pituitary adenomas with sphenoid sinus and/or parasellar extension — 14 (35.9 %), sphenoid sinus tumors (carcinoma, neurilemmoma, fibrous dysplasia, angiofibroma, esthesioneuroblastoma) — 8 (20.5 %), petroclival tumors — 6 (15.4 %): hemangiopericytoma — 1, clival tumors — 5 (chordoma), sella turcica lesion with posterior clinoid recess extension (osteoma) – 1 (2.5 %). The extended EET approaches used were as follows: EET + transpterygoid approach — 22 (56.4 %) (in 4 (18.1 %) cases transmaxillary approach was additionally used), extended EET + transclival approach — 4 (10.2 %), EET + transcavernous approach — 2 (5.1 %), EET + transethmoidal approach — 11 (28.2 %). In all cases, we used Karl Storz rigid 4mm 18cm with 0 and 30-degree angled optics. The extent of resection was determined based on routine postoperative CT scans performed within 24 hours after surgery. The volume of resection was evaluated using gadolinium. Gross total resection was defined as the resection of 100 % of the target lesion, subtotal resection as less than 100 % volumetric reduction of the lesion on postoperative CT scans. Further follow-up was done in three, six months and 1 year after surgery, then annually by MRI scanning with gadolinium.Results. Gross total resection was achieved in 7 (77.8 %) cases of tumor in pterygopalatine fossa. In cases of pituitary adenomas with Knosp 3, Knosp 4 cavernous sinus extension, gross total resection was achieved in 7 (53.8 %) individuals. Sphenoid sinus tumors were totally removed in 5 (62.5 %) cases. Subtotal resection was achieved in 11 (28.2 %) cases. Partial resection was achieved in 8 (20.5 %) cases. Postoperative complications were observed in 5 (12.1 %) cases.Conclusions Transethmoidal extended endoscopic endonasal approach is sufficient and good to access the anterior wall of the cavernous sinus improving visualization and better removing of cavernous sinus pathology extension. Transpterygoid extended endoscopic endonasal approach provides sufficient visualization of pterygopalatine fossa, petroclival region. Transmaxillary extension allows reaching the subtemporal region

Ce-doped Li6Ln(BO3)3 (Ln = Y, Gd) Single crystals fibers grown by micro-pulling down method and luminescence properties

Ce3+-doped borate crystal fibers of Li6Gd(BO 3)3 (LGBO) and Li6Y(BO3)3 (LYBO) compositions are grown by the micro-pulling down (μ-PD) method for potential application in developing new neutron detectors. The ternary equilibrium diagram of Li2O-Gd2O3-B 2O3 is drawn and the preparations of homogeneous mixed LGBO and LYBO powders and growth conditions for single crystal fibers are discussed. Absorption, excitation and X-ray luminescence spectra are investigated. Absolute light yield derived from energy spectra and kinetic decay curves measured under α- and γ-scintillations of Ce 3+-doped LGBO and LYBO single crystal fibers is provided. © 2012 Elsevier B.V. All rights reserved

Limitations and opportunities of cancer treatment in the COVID-19 pandemic

The COVID-19 pandemic has affected all medical fields and brought up a lot of serious problems. The features of the COVID-19 infection in patients with cancer are important to understand. According to many articles, patients with cancer are more vulnerable to COVID-19 infection. Patients undergoing anticancer treatment have 1-4% morbidity rate. Patients with hematological diseases and lung cancer are at higher risk of SARS-CoV-2 infection and also have more severe symptoms and complications. In this article we discuss the effect of the tumors on the immune system and comprehend the pathogenesis of the coronavirus disease according to its impact on the immunity. Moreover, in the review we analyze available data about the influence of the different types of cancer therapy (chemotherapy, target therapy, radiotherapy and immunotherapy) on the severity of the COVID-19 infection. Evidence on the effect of chemotherapy on severity and mortality from COVID-19 is contradictory. Whereas there are some authors concluding that chemotherapy treatment is not affecting the severity of COVID-19 disease, there are also some works where the connection between these facts was established. At the same time target therapy, radio- and immunotherapy most likely do not worsen the SARS-CoV-2 infection and are not associated with the development of complications. But it’s important to say that the amount of data available for today is insufficient to make a unambiguous conclusion

Model of demand for labor in the urfo pharmaceutical market

The purpose of the study is to comprehensive assessment of the structure of demand for labor in the pharmaceutical market of the URFO to build empirical functions of the demand for labor resources for pharmaceutical specialists with different qualifications.Цель исследования – комплексная оценка структуры спроса на труд на фармацевтическом рынке УрФО для построения эмпирических функций спроса на трудовые ресурсы для фармацевтических специалистов с разной квалификацией

Використання сучасних технологій в управлінні сучасним процесом на кафедрі ортопедичної стоматології з імплантологією

Обґрунтовується ідея підвищення якості підготовки фахівців шляхом цілеспрямованого регулярного корегування змісту навчання відповідно до вимог розвитку суспільства і формування ринку праці. Автори доводять, що використання сучасних інформаційних технологій, активних форм і методів навчання забезпечує розвиток самостійності студента

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health